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Jousse-Joulin S, D'Agostino MA, Nicolas C, Naredo E, Ohrndorf S, Backhaus M, Tamborrini G, Chary-Valckenaere I, Terslev L, Iagnocco A, Collado P, Hernández-Díaz C, Gandjbakhch F, Schmidt WA, Filippou G, Dejaco C, Stradner MH, Mortada MA, Hočevar A, Chrysidis S, El Mardenly G, de Agustín JJ, Thiele R, MacCarter DK, Finzel S, Hanova P, Zabotti A, Glaser C, Alavi Z, Hammenfors DS, Gatineau F, Bruyn GA. Video clip assessment of a salivary gland ultrasound scoring system in Sjögren's syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise. Ann Rheum Dis 2019; 78:967-973. [PMID: 31036626 DOI: 10.1136/annrheumdis-2019-215024] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/21/2019] [Accepted: 03/23/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To develop ultrasound (US) definitions and a US novel scoring system for major salivary gland (SG) lesions in patients with primary Sjögren's syndrome (pSS) and to test their intrareader and inter-reader reliability using US video clips. METHODS Twenty-five rheumatologists were subjected to a three-round, web-based Delphi process in order to agree on (1) definitions and scanning procedure of salivary gland ultrasonography (SGUS): parotid, submandibular and sublingual glands (PG, SMG and SLG); (2) definitions for the elementary SGUS lesions in patients with Sjögren's syndrome; (3) scoring system for grading changes. The experts rated the statements on a 1-5 Likert scale. In the second step, SGUS video clips of patients with pSS and non-pSS sicca cases were collected containing various spectrums of disease severity followed by an intrareader and inter-reader reliability exercise. Each video clip was evaluated according to the agreed definitions. RESULTS Consensual definitions were developed after three Delphi rounds. Among the three selected SGs, US assessment of PGs and SMGs was agreed on. Agreement was reached to score only greyscale lesions and to focus on anechoic/hypoechoic foci in a semiquantitative matter or, if not possible on a qualitatively (present/absent) evaluation of fatty or fibrous lesions. Intrareader reliability for detecting and scoring these lesions was excellent (Cohen's kappa 0.81) and inter-reader reliability was good (Light's kappa 0.66). CONCLUSION New definitions for developing a novel semiquantitative US score in patients with pSS were developed and tested on video clips. Inter-reader and intrareader reliabilities were good and excellent, respectively.
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Affiliation(s)
- Sandrine Jousse-Joulin
- Rheumatology, Brest Medical University Hospital, INSERM ESPRI, ERI29, UBO, Brest, France
| | - Maria Antonietta D'Agostino
- Rheumatology, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France, INSERM U1173, Laboratoire d'ExcellenceINFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Montigny le Bretonneaux, France
| | - Celine Nicolas
- INSERM, CIC 1412, Brest University Hospital, Brest, France
| | | | - Sarah Ohrndorf
- Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin, Germany
| | - Marina Backhaus
- Rheumatology and Clinical Immunology, Universital Hospital Charit, Berlin, Germany
| | | | - Isabelle Chary-Valckenaere
- Rheumatology, Nancy University Hospital and UMR 7365 CNRS-UL IMoPA (IngéniérieMoléculaire & Physiopathologie Articulaire), Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Lene Terslev
- Centre for Rheumatology and Spinal Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Rome, Italy
| | - Paz Collado
- Rheumatology, Severo Ochoa University Hospital, Madrid, Spain
| | - Cristina Hernández-Díaz
- Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Frederique Gandjbakhch
- Rheumatology, CHU Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, Paris, France.,GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris 6 University, Paris, France
| | - Wolfgang A Schmidt
- Rheumatology, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Georgios Filippou
- Rheumatology Section, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Christian Dejaco
- Rheumatology, Medical University Graz, Graz, Austria.,Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | | | | | - Alojzija Hočevar
- Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | | | | | - Ralf Thiele
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Stephanie Finzel
- Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Petra Hanova
- Rheumatology, Institute of Rheumatology, Prague, Czech Republic.,Rheumatology, Hána CB spol s r o, Ceske Budejovice, Czech Republic
| | - Alen Zabotti
- Department of Medical and Biological Sciences, Rheumatology Clinic, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Cornelia Glaser
- Department of Rheumatology and Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Zarrin Alavi
- INSERM, CIC 1412, Brest University Hospital, Brest, France
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